ectopic pregnancy Flashcards
(20 cards)
what
pregnancy implanted outside uterus
most common site = fallopian tube
risk factors
prev ectopic prev PID prev tubal surgey assisted conception IU device - coil older age smoking
presentation
missed period right lower abdo/LIF pain vaginal bleeding lower abdo/pelvic tenderness cervical motion tenderness
Ix
BHGC
USS
USS findings
no intrauterine gestational sac
adnexal mass
fluid in pouch of douglas
pregnancy of unknown location
woman has + pregnancy test and no evidence of pregnancy on USS
PUL - monitoring
HCG trakced over time - repeated 48hrs
HCG rise >63% after 48hrs
indicated intrauterine pregnancy
HCG rise <63% after 48hrs
may indicate ectopic pregnancy
HCG fall >50%
likely to indicate misscarriage
pregnancy test should be performed after 2wks to confirm misscarirage is complete
Mx options
expectant
medical - methotrexate
surgical
criteria for expectant Mx
- follow up must be possible
- ectopic is unruptrues
- adnexal mass < 35mm
- no visible heartbeat
- no significant pain
- HCG < 1500 IU/L
expectant management - follow up
monitor hCG
criteria for Mx with methotrexate
- follow up must be possible
- ectopic is unruptrues
- adnexal mass < 35mm
- no visible heartbeat
- no significant pain
- HCG < 5000 IU/L
- confirmed absence intrauterine pregnancy on USS
Mx with methotrexate - advice to women
don’t get pregnant for 3mo following treatment
Mx with methotrexate - methotrexate side effects
vaginal bleeding
N&V
abdo pain
when to use surgical Mx
pain
adnexal mass >35mm
visible heartbeat
HCG >5000 IU/L
1st line surgical Mx
laparoscopic salpingecotmy
when is salpingotomy done
inc risk of infertility due to damage of other tube
what is given to rhesus negative women having surgical management of ectopic pregnancy
anti-rhesus D prophylaxis
